How And Why Do NGOs Attempt to Scale up Their Development Efforts Essay

How And Why Do NGOs Attempt to Scale up Their Development Efforts - Essay Example This report stresses that twentieth century globalization gave NGO’s a whole new lease because many problems arose that could not be solved within a nation. International treaties and organizations such as World Trade Organization were considered biased towards capitalist interests. NGOs lay emphasis on humanitarian issues, developmental aid and sustainable development which helped in counterbalancing the capitalist trend. A prominent example of this is the World Social Forum, a rival convention to the World Economic Forum held annually in Davos, Switzerland. The fifth World Social Forum in Porto Alagre, Brazil, in January 2005 was attended by representatives from more than 1,000 NGOs. This article makes a conclusion that in the era of information technology, individuals and organizations serving community interests are challenged to incorporate new skills and strategies to scale-up their impact in response to social challenges. In an increasingly interconnected and information-intensive environment, strategically managing information and value systems is rapidly becoming as important as sound financial management to an organization's effectiveness and sustainability. A firm value system helps Visioning and valuation-facilitating the development of organization-wide commitment to enhanced communications and Communications planning to construct innovative and appropriate organizational strategies which aids in Fostering internal and external networking.

Zara: Business Expansion Strategies

Zara: Business Expansion Strategies Executive summary This article examines the case of the Spanish clothing retailer Zara’s experience of and plans for further expansion into Southern and Northern American markets. It argues that given the unique distribution and production functions of the retailer that possible problems exist for continued expansion in the US market. The problems associated with this given the characteristics of local markets and pressures from rival operators’ means that a recommendation is made for an adjusted international strategy for the company despite its broad successes elsewhere globally. Introduction Globalisation has become an essential element of international marketing principles and it has been argued that one of the keys to success in global markets is the effective development and marketing of standardised products and brands (Douglas Wind, 1987). Jay (2000) suggests that the development of international enterprises is as a consequence of reduced barriers for trading due to developments in information technology. Jones (2002) argues that successful international operations are those which integrate and cooperate in business activities across national boundaries. It is clear that the clothing industry is a significant part of the internationalisation process in terms of the critical growth of the clothing retailing sector in global markets and attendant activities such as global sourcing. The international expansion of Zara is led by its parent company Grupo Inditex which is based in Spain and Zara has achieved an impressive annual growth of 26% over the last five years (D’Andrea Arnold, 2002). Based in Spain Zara has grown from 180 stores to 1.080 stores in 33 countries and in 2002 150 stores were added in 9 countries and further expansion has been planned and expected. As the biggest economy in the world the American market is an attractive one for Zara and stores located in New York were announced as being successful indicators towards future market penetration. The huge American market and especially the North American marketplace was highlighted as the next move for the company’s expansion plan yet the diversity in this market and high level of competition creates challenges for continued Zara’s success. Environmental Analysis A clear understanding of the business environment is essential for companies in competing in the global economy. This is particularly important in relation to international strategy. Environmental analysis can be made from both a macro and micro perspective and both the PESTEL and Porter’s industrial analysis are useful instruments of analyses (Johnson Scholes, 2002). PESTEL analyses the political, economic, social, technological, environmental and legal events that have impacts on a business. Of interest in this case is the signing of the North American Free Trade Agreement (NAFTA) which helped regional economic growth among member countries through eliminating tariffs and government encouragement of foreign direct investment. This creates threats to Zara in terms of an entry model as well as marketing strategy. The American market is highly attractive for multinational companies such as Zara. The US is the number one economy in the world although since the terrorist attacks in 2001 the American economy slowed down accompanied with a reduction in consumer confidence. According to Jobber (2001) where national economic performance and customer confidence is poor consumers will reduce consumption of non essential products. This poses problems for Zara in competing in a highly competitive marketplace where demanding for clothing has decreased. Zara however provides luxury clothing products at a reasonable price which provides the company with competitive advantages in terms of price, quality and brand name. The success of Zara depends on an effective logistics system and it is one of the few companies with in-house design and production enabling them to provide new clothing lines within 15 days instead of the 9 months average lead-in time of the textile and clothing industry. It is fair to say that this logistics system based on information technology and computerized design and production programs enables Zara to maintain competitive advantages over other international competitors. However previous experiences in operating in South America where a complex and large distribution centre was established in order to supply the southern region saw challenges in the integrated supply chain being created. Language as one of the most important elements of culture plays a vital role in shaping international marketing strategy simply because people under different social and cultural environments share different value systems and display varied consumer behaviour (Bradley, 2005). Additionally it is useful to be aware of the new form of political economy which suggests that economic phenomena are highly linked with political issues in that governments seek to use political power to achieve economic benefits (Rugman Hodgetts, 2003). Examples of this can be seen in the increasing role of developing countries in the world economy. In the case of the textile and clothing industry more and more retailers and manufacturers source from lower labour cost developing countries res ulting in significant competitive pressures on Zara which insists on sourcing mainly from Europe and relying on its in-house design and production. Porter (1980) provides a useful framework in understanding the industrial environment in which companies are involved in. The competitive level in an industry shapes a firm’s strategy in competing in its marketplace and in turn this is shaped by the performance of operators within the industry. It is obvious that competition levels are high in both the North and South American marketplace. Zara entered the South American market where American brands such as GAP and the Swedish brand HM were major competitors within the middle clothing market. Similarly buyer power has increased in the modern business environment and Zara needs to effectively satisfy customers globally from different nations and cultural backgrounds. Improvement in US consumer confidence demonstrated in the research creates opportunities for Zara in expanding its market from south to the north (BBC News, 2005). Nevertheless the issue of different supply systems needs to be resolved utilising Zara’s integ rated global supply and logistics chain. The strategic plan to establish a specific supply and distribution centre for the North America market aims to control cost and maintain competitive capabilities in competing with companies from member countries of NAFTA such as Canada and Mexico as well as local players who source from cheaper overseas suppliers. Due to the nature of the clothing retailing industry the diversity of retailing forms in the US is complex including both large numbers as well as different formats for retailers including large retailers, department stores, merchandise shops, small specialty operators and discount stores. There are potential new entrants into this marketplace and hence it is critical for Zara to be aware of the high competition level in the US clothing retailing industry at all levels of the market. Market Segmentation Market segmentation aims to provide relevant information for a basis for the selection of target markets (Bradley, 2005). Zara’s targeted customers are people who seek for higher quality clothing products at reasonable prices. In this case targeted American customers were those who expressed interest in European branded clothes. First of all Zara’s women collection is divided into three categories: Zara Women, Zara Basic and the sporty Trafaluc representing market segments for women who look for a more formal style, younger women for a more informal style and younger women and teenagers while menswear included Men’s Line at Zara, Zara Basics, its club-wear brand 100Zara and Zara Sport (D’Andrea Arnold, 2002). In this sense the general public from all age groups can be seen as potential customers targeted by specific sub-brands of Zara. A second important variable in defining segmentation is based on psychographic characteristics such as lifestyle which wi ll be discussed in detail in the next section (Jobber, 2001). As one of the most famous and successful European brands Zara in its existing south American market targeted people who were especially interested in European styles at affordable price levels. This targeting strategy remained the same for Zara in expanding in the North American marketplace. One definition of consumers suggests that it can be seen as individuals as well as groups of people purchase products or services for personal use, household or gifts. In other words they can be classified as end users of particular products (Solomon et al, 2002). Retailers are situated in the final steps of the distribution chain and are closely linked with end users or customers. Therefore it is useful to look at the concept of consumer behaviour in relation to clothing buying in light of target segmentation strategies pursued by Zara. Blackwell, Miniard and Engel (2000) define the initial step of consumption processes as the recognition of needs which can be influenced by various factors such as reference group values, self esteem and external cultural and social value systems. Particularly modern customers have become more sophisticated and learn more from their purchasing experiences with price often deployed as a key indicator as to the quality of goods (Jobber, 2001). This is arguably the case for buying activity in the clothing sector with brand name, price, style as well as quality tending to have important effects on the decision making processes leading to purchasing. According to Entwistle (2000) clothing is not simply about physical garments but takes on a multi-faceted significance where people use fashion to define and negotiate their identity in wider social contexts. Increasing power for consumers enables them to bargain for lower priced clothing yet it remains the case that pure discount on price is not necessarily important for them in make purchasing decisions. This aspect of consumer behaviour offers a useful insight for Zara in establishing its competitive advantages based on an effective logistics and supply chain through ensuring quality with reduced costs matched to a strong brand name. Foxall, Goldsmith and Brown (1998) argue that there are several stages after need recognition leading to final buying activity and as such the co mmunication strategy used to build up effective customer relationships and brand image by clothing retailers is most useful at the early stage in order to have a lasting impact on purchasing decisions. In this retail context women are suggested to constitute a major proportion of consumers (Domosh, 1996). Particularly women are more involved in both social and economic life functions which results in increasing demands on fashion in terms of style and self identity. Additionally a determinant of the degree to which customers evaluate a brand is the level of involvement with high involvement meaning extensive evaluation of the product and/or alternatives (Hawkins, Best and Coney, 1989). For clothing products the degree of involvement is suggested as being typically medium to high (Breward, 2000). Bearing in mind the concept of involvement and the role of women in purchasing Zara used a suite of effective marketing tools in maintaining customer loyalty through providing value added clothing relevant to identified market preferences. This is because in terms of fashion a stylish and sophisticated brand image in terms of trends, styles and tastes is a key success factor in building a b rand name for a retailer such as Zara. Similarly effectively maintaining customer loyalty in terms of repeat buying is a major contributor to successfully expanding its market share in the US market. Marketing Strategy Analysis and Evaluation Based on its successful experience in operating in New York Zara pursued a strategic market expansion strategy in order to maintain organisational growth in terms of market share and the accruement of financial benefits. The establishment of a distribution centre in the outskirts of Buenos Aires enabled Zara supply the southern region as well as played a strategic role in supplying the new northern market (D’Andrea Arnold, 2002). With Zara being one of the few companies utilising in-house design and production meant sourcing locally was its main strategy rather than switching to overseas suppliers. This strategic choice did enhance the competitive capabilities of Zara in terms of short lead time and effective logistics control but added to pressure from competitors who sourced abroad resulting in competitive pricing in the middle market by rivals such as HM and GAP. In addition in considering an integrated supply chain the distribution centre to some extent caused inefficiencies in the overall system in that decisions on the choice of local manufacturers had been made difficult due to the closure of American textile and clothing manufacturers who moved production lines to Asia. As such the market expansions strategy remains unclear in terms of it achieving growth based on effective franchises rather than through adding new stores and entering new markets. This can be said to be especially the case for the North American market. Although the market size is large and entry barriers are low due to the cultural differences between south and north US regions means significant attention must be paid to the marketing mix in order to achieve synergy from integration. Life styles are different in North and South America hence the branding strategy used by Zara is essential in differentiating itself with both from existing rivals and attracting new custom ers within each of the respective markets. Evaluation of marketing mix In the context of international market and keeping in mind different macro and micro environmental conditions an international marketing mix needs to be varied from one context to another (Keegan Green, 2003). Based on the branding marketing mix strategies it is of importance to look at international marketing models in the North American market considering different operational environments and different consumer behaviour in southern and northern markets. Product and brand The term product not only refers to tangible goods but also entails intangible attributes such as customer service and brand name (Keegan Green, 2003). As a retailer Zara provides a similar range of products in both the southern and northern markets in the US as those provided in its domestic market. However the intangible resource which Zara as a strong brand in New York occupying the middle fashion market appears to be less visible more broadly in the North American markets in comparison with the national brand image of GAP. Traditionally the brand image of Zara as a retailer is one targeted on middle income consumers seeking high fashion styles at reasonable prices. As a result of successful operation in the EU market as well as Asian and South American markets Zara was able to create a strong brand image in the middle fashion market in order to compete with GAP and HM who are also two major operators in the wider global market. Price Price is argued as being an important indicator for customers in evaluating the quality of products and within the clothing sector this also holds true (Easey, 2002). The price mix deployed in the US market is double that found in its domestic region in Spain due to higher operational cost and higher labour costs. It has been suggested that the clothing industry is labour intensive and that effective human resource management strategy contributes in a key manner to effective cost control and in turn allow for competitive pricing in the market (Jones, 2002). As a result the operational strategy employed by Zara has been consistently challenged by competitive pricing from competitors who source from cheaper developing countries. As a result the efficacy of an integrated logistics and supply chain can be questioned along with the ability of maintaining this over the long term given the diversity and complexity of the clothing manufacturing industry in the US. In sum Zara’s operat ion in international markets appears to be experiencing rapid growth in terms of new branches and improving sales and profit but longer term challenges need to be addressed as a priority. Easey (2002) argues that pricing regimes for clothing products may need to change depending on different characteristics in each national market but that communication and management of these changes need to be directed from a strategic level. Communication An integrated communication strategy is an important part of the marketing mix within a branding strategy framework. This seems to be even more essential in the clothing retailing industrial context involving the use of celebrities as a critical communication tool in communicating with customers. For Blythe (2000) marketing communications objectives are created in order to develop a customer base and improve sales through increasing both new and existing customers’ expenditure on a brand’s products. However Zara has rarely exploited advertising campaigns except in the case of its launch of two main product ranges occurring seasonally each year. This can help explain its low brand awareness in the North American market which is a threat to successful entry into this marketplace. Additionally visual merchandising such as store design and layout has become widely regarded as important communication tools with consumers (Lea-Greenwood, 2002). In the case of Zara store design such as clear lighting, white walls and ceiling and style-related decorations such as photographs were deployed in order to create an elegant atmosphere emphasising a brand image reflecting European trends. Likewise employee uniforms helped Zara maintain a visual and physical presence of the brand image and helped in communicating with customers and needed only minor adjustments between southern and northern stores. It is believed that the format and experience of a trading environment particularly in clothing retailing interacts closely with merchandise, customer service and the success of communications strategies (Walters Hanrahan, 2000). It can be argued that the communication strategy used by Zara is effective in terms of communicative effects and of a lower cost than its competitors. On the other hand establishing a significant nationwide presence in North America may require either a large expenditure on a celebrity endorsed campaign or the ef fective use of novel techniques such as viral marketing. Distribution The distribution channel is the network which links producers with users yet international distribution strategies are difficult to manage since distribution structures differ from one country to the next (Keegan Green, 2003). For Zara the US market presents unique challenges. As mentioned earlier the closure of US local manufacturers and moves to Asian manufacturing operations poses major threats to Zara which traditionally exploits local sources in supporting its in house design and production. Due to the highly fragmented nature of fashion retailing it is vital for Zara to differentiate itself from other competitors during its entry stage into the North American market. In considering these difficulties in enter this market and the different cultural backgrounds involved Zara pursued an organic growth in terms of opening stores in its expansion. This is because a strong financial background based on its successful operation both in New York and support from its parent company Grupo Inditex allowed for a longer term fiscal view to be taken. However the use of English in the US market is likely to present challenges for the Spanish company but successful international human resource management should counter this and lead to successful implementation of its strategic expansion plans. Figure 1: Global Retailing Market Entry Strategy Framework Source: Horovitz, J. Kumar, N. (1998) Strategies for Retail Globalization, London UK, Financial Times. Conclusion In order to maintain organizational growth Zara employed an aggressive expansion strategy in responding to internationalisation and globalisation. Research demonstrates that a strong global brand name is one of the most vital elements contributing to the success of international operations (Wigley et al, 2005). However a key consideration is cultural influences which have shaped international marketing strategies for Zara in the US market. An international marketing strategy to some degree remains the same as strategies used in other markets satisfy targeted customer groups effectively. However because of local differences and consumer complexity in the American market adjustments were used such as the establishment of a dedicated distribution centre for the American market. Recommendations The marketing mix used by Zara in the US market has been more effective in New York than in other locations. Brand name is a significant part of product concept hence it is useful for Zara to cooperate with local fashion magazines in conducting magazine campaigns in order to improve brand awareness at the market entry stage. Lea-Greenwood’s (2002) suggestion that the communication process involves three key participants namely sender, message and receiver must be added to in the sense that practical contexts of business operations in the clothing retailing sector makes this model more complex due to changing forces in the external environment such as developments in media technology and changing characteristics/preferences of consumers. This is also of particular importance in international markets as different cultural and social backgrounds have substantial impacts on consumer behaviour as well as effective communication models. Secondly higher costs resulted in higher prices for Zara in these locations. This phenomenon is able to generate potential risks to its brand image of quality clothing products at reasonable prices. It is undoubted that in house design and local sourcing provides Zara with competitive advantages such as short lead times and high response rates to clothing trends but an awareness of local characteristics in the marketplace is essential. In the case of international expansion currency rates have a major impact on operational and labour costs. In turn competitiveness on price might be eliminated because of pressures from competitors who are able to provide even cheaper but goods which are of high quality. As Jones (2002) highlights global sourcing is a key trend and will continue to be so due to globalisation. Although sourcing abroad raises concerns on supply chain related risks which are often called the Iceberg theory it is imperative that Zara be aware of the significant advantages of sourcing from countries with lower labour costs especially given that quality levels have improved (Jackson Shaw, 2001). With the North American market there were difficulties for Zara in maintaining its famous on an in house production model simply because of a lack of local suppliers and manufacturers. Additionally labour costs in America are considerably higher compared to its operation in Europe. It is hard for Zara then to enjoy cost advantages offered by Eastern European countries as well as cheap domestic cost in Spain (Jones, 2002). The suggestion here is to consider expanding operations to Mexico which is comparably cheaper than the US yet offers a distribution channel to the North American market. The establishment of a distribution centre in Mexico is more likely to be cost effective rather th an building specific manufacturing factories in order to supply the North American market. References BBC News (2005) US Consumer Confidence on the Up, BBC News, December 28th, available from:Â  http://news.bbc.co.uk/1/hi/business/4564766.stm> Blackwell, R.D., Miniard, P.W. Engel, J.F. (2000) Consumer Behaviour, USA, Dryden. Bradley, F. (2005) International Marketing Strategy 5th edition, Harlow UK, FT Prentice Hall. Breward, C. (2000) Cultures, Identities, Histories: Fashioning a Cultural Approach to Dress, in White, N. Griffiths, I. (eds) The Fashion Business: Theory, Practice, Image, Oxford New York, Berg. D’Andrea, G. Arnold, D. (2002) Zara, Harvard Business School, January 30. Domosh, M. (1996) The Feminized Retail Landscape: Gender, Ideology and Consumer Culture in 19th Century New York City, in Lowe, M. and Wrigley, N. (eds) Retailing, Consumption and Capital, UK, Longman Group Limited. Douglas, S.P. Wind, Y. (1987) The Myth of Globalisation, Columbia Journal of World Business, Vol. 22. Easey, M. (2002) Fashion Marketing 2nd edition, Oxford UK, Blackwell Publishing. Entwistle, J. (2000) The Fashioned Body, Cambridge UK, Polity Press. Foxall, G.R., Goldsmith, R.E. Brown, S. (1998) Consumer Psychology for marketing 2nd edition, London UK, Thomson Business Press. Hawkins, D.I., Best, R.J. Coney, K.A. (1989) Consumer Behaviour: Implications for Marketing Strategy, Boston USA, Mass. Hesmondhalgh, D. (2002) The Cultural Industries, London UK, Sage. Horovitz, J. Kumar, N. (1998) Strategies for Retail Globalization, London UK, Financial Times. Jay, P. (2000) The Road to Riches, London, Weidenfield and Nicholson. Jackson, T. Shaw, D. (2001) Mastering Fashion Buying Merchandising Management, Basingstoke, Palgrave Jobber, D. (2001) Principles Practice of Marketing 3rd edition, London UK, McGraw-Hill. Johnson, G. Scholes, K. (2002) Exploring Corporate Strategy: Text and Cases 6th edition, London UK, FT Prentice Hall. Jones, R.M. (2002) The Apparel Industry, Oxford UK, Blackwell Publishing. Keegan, W.J. Green M.C. (2003) Global Marketing 3rd edition, New Jersey, Prentice Hall. Lea-Greenwood, G. (2002) Fashion Marketing Communication, in Easey , M. (ed) Fashion Marketing 2nd edition, Oxford UK, Blackwell Publishing. Porter, M.E. (1980) Competitive Strategy: Techniques for Analyzing Industries and Competitors, New York USA, The Free Press. Rugman, A.M. Hodgetts, R.M. (2003) International Business 3rd edition, Harlow UK, FT Prentice Hall. Singleton, J. (1997) The World Textile Industry, London UK, Routledge. Solomon, M., Bamossy, G. Askegaard, S. (2002) Consumer Behaviour: A European Perspective, Harlow England, FT Prentice Hall. Walters, D. Hanrahan J. (2000) Retail Strategy: Planning and Control, London UK, MacMillan Business. Wigley, S.M., Moore, C.M. Birtwistle, G. (2005) Product and Brand: Critical Success Factors in the Internationalisation of a Fashion Retailer, Journal of Retail Distribution Management, Vol. 33 No. 7.

Buffalo Springfield :: folk-rock country-rock

Aside from the Byrds, the only other band that had a tremendous influence on folk-rock and country-rock in the sixties was Buffalo Springfield. They were noted as a key impact upon the counter-culture of the sixties, and their music is symbolic of the turbulence and controversy that surfaced during harsh times of war. The group’s formation was coincidental and legendary. Stephen Stills and Richie Furay were driving on Sunset Boulevard in Los Angeles in early April 1966, when by chance they pulled up behind a tattered black Pontiac hearse bearing Canada license plates. The car held Neil Young, a Canadian Stills had crossed paths with earlier, and Bruce Palmer, a bass player. The two were on search of their musical dreams when they fused with Stills and Furay, and began to work for status as a rock and roll band. Buffalo Springfield was soon signed with Atco Records, and began producing their self-titled debut album. This record contained the famous song, â€Å"For What It’s Worth,† which transcended pop charts to become an anthem for an entire generation. Their second album, Buffalo Springfield Again, achieved great acclaim for the powerful songs from Stills, Young, and Furay.   Ã‚  Ã‚  Ã‚  Ã‚  Though Buffalo Springfield was established as the best folk-rock band in the sixties, the band was not intact for long. Even with the success that followed their popular albums, problems arose within the members of the group. Particularly, Stills and Young had stubborn, conflicting personalities. This lead to several rearrangements among members of the band. Young would often leave the group for long periods of time, while Palmer fought deportation.

Film Review: Stella Dallas

Sophia Sullivan FLM2009-630: The Art of Film M. Brown Melodrama Stella Dallas (1937) Dir. King Vidor. Starring: Barbara Stanwyck, John Boles, Anne Shirley, Barbara O’Neil, Alan Hale. MGM (DVD) This film follows our protagonist, Stella (Barbara Stanwyck) through her journey of courtship, marriage to loss. Stella sneaks her way into meeting Stephen Dallas (John Boles) after finding out in a tabloid magazine article about his family fortune being loss and him ending his engagement to Helen (Barbara O’Neil) the socialite.Stella’s complete devotion to her daughter Laurel (Anne Shirley) and her reluctance to change who she is, keeps her from moving to New York with her newly promoted husband Stephen (John Boles). Living separate lives, not completely confessing to the fact that the couple was what would currently be called â€Å"legally separated† due to probable censors. The film’s thematic of maternal sacrifice and the loneliness, devotion of the film c ause this movie to become what is known in the film industry as a â€Å"Weepie†.The Mise-en-scene of the film is predominantly domestic and focused on the excesses of interiors and Stella’s outlandish fashions. The film cannot be categorized as realistic, even though it seems naturalistic at times. The storytelling of Stella’s constant journey to better her life and that of Laurel’s, is purely stylized. Stella’s persona sticks out like a sore thumb against the socialite circles, dressing in the eccentric fashions she deems as stylish, speaking too loud, not fitting into the lady-like deportment her husband demanded.This being the mother ship of all maternal melodramas, Stella sets a mold for the many to follow. The constant waves of swoony and dramatic music create an emotional musical blanket throughout the film. Setting the moods in the scenes from happy to sad with one wave of the conductor’s hand. The acting at times seemed unnatural and campy, like a modern day Soap Opera. The lives and differences of the social classes in this film was popular at the time. I guess being that a large percentage of the populace were currently lower to middle class Americans.The theater was the ultimate form of escapism to the masses. The melodrama was a peephole of sorts into the gorgeous and painfully dramatic lives of the wealthy. Stella ends up making the definitive maternal sacrifice at the end of the film. She turns her daughter against her to guarantee her daughter the future she herself wanted one time, forsaking her own happiness. To give up a child so that child could be happy is a dreadfully painful sacrifice to any loving mother.In the final scene of the film, Stella watching with the crowd outside the window of Stephen’s new home, as their daughter weds into a wealthy family. Laurel now is not associated with the brassy Stella and has been accepted into the social circle of the elite. She watches as Laurel weds, with tears rolling down her face, the rain soaking her. She then turns away and walks down the street triumphantly with a huge smile on her face. This feminine sacrifice completes her daughter’s road to happiness. The melodrama is known for its sudden shift in emotions.One moment Stella is yelling at her daughter for finding the dress she was making her as a surprise and ten seconds later she is hugging her and telling her how much she loves her. In my opinion this genre juxtaposes moments of utter happiness and bliss with the abrupt change to hysterics and tears far too quickly to not require a psych consult. I know this film is a classic and a classic to the melodrama genre, but I just don’t get it. I guess it was the social norm at the time to look upon women with esteem for giving everything up to guarantee the happiness of child, marriage and home.But then again she could have been happy enough with herself to not want to marry someone just to better herself. She would marry someone who loved her for who she was and where she came from. She could of raised her child with a strong sense of self that would have her become a role model and not an embarrassment. I speculate that was not the case when it came to creating a melodrama. Thank you King Vidor for creating the blueprint for all Lifetime Channel movies. Like sands through the hourglass†¦..

Chicken Wings

Chlamydia is the most common bacterial sexually transmitted infection (STI) in Canada. When left untreated, it can lead to painful physiological problems and sterility defects. Despite being in decline for many years, rates of chlamydia infection have risen steadily since 1997. These rising rates show that people are not using safer sex methods on a consistent basis. This STI is transmitted through vaginal, anal, or oral sex, and can also be transmitted from mother to child during childbirth.Chlamydia exists as one of many issues concerning safe sex across Canada. In terms of unprotected or unsafe sex, it is important for people to test for Chlamydia. It is known as the ‘silent disease', because more than 50 percent of infected males and 70 percent of infected females have no symptoms and are unaware of their condition. Physiological effects usually begin to appear two to six weeks after infection, but it can take longer. If the STI is left untreated, beginning symptoms include : Women Men -A vaginal discharge-A discharge from the penis A burning sensation when urinating-A burning sensation when urinating -Vaginal bleeding between periods or after intercourse-Pain and/or swelling in the testicles -Pain in the lower abdomen-Pain in the lower abdomen If the STI is still not treated after initial symptoms, long-term effects for both sexes may include Pelvic Inflammatory Disease (PID), which is irritated skin in the pelvic region, and also a decrease in fertility rates. Even without symptoms, however, chlamydia can be transmitted and can lead to serious health problems and sterility, especially in women.Anyone at risk should therefore be tested. Support Services Health Canada's Sexual Health and Sexually Transmitted Infections Section provides national leadership and coordination through programs that develop and support surveillance and targeted research studies. Working with provincial and territorial governments, non-governmental organizations and health ca re providers, the Section develops evidence-based national standards and policies, promotes the exchange of information and engages in prevention and promotion activities.Additional Info: Minimizing RiskFollowing these suggestions may help you to protect yourself from contracting chlamydia: Learn about safer sex methods. Make informed decisions. Talk to your partner(s) about their STI status and the use of protection. Correct use of condoms reduces the risk of acquiring chlamydia and other STIs. Get tested for chlamydia if you are sexually active. If you are diagnosed and treated for chlamydia, be sure to follow your health care provider's treatment and follow-up recommendations.If infected, you should abstain from sex until both you and your sexual partner(s) have completed your antibiotic treatment. You can easily be reinfected if your partner is not treated as well. It is important that you or someone from your public health department notify any of your sexual partners who may h ave been put at risk of infection. They will also need to be tested and possibly treated.

In what ways is The Signalman a typical ghost story Essays

In what ways is The Signalman a typical ghost story Essays In what ways is The Signalman a typical ghost story Paper In what ways is The Signalman a typical ghost story Paper The Signalman describes the steam from the train as vapour The driver of the train which runs down the signalman describes his actions just before the train he was driving killed the signalman:- Ah it was a dreadful time, sir. I never left of calling to him. I put this arm before my eyes not to see, and I waved this arm to the last; but it was no use. And finally after hearing the signalmans state of anguish the narrator tries to decide what to do next:- Though in a subordinate position, still he held a most important trust, and would I (for instance) like to stake my own life on the chances of his continuing to execute it with precision? As you can see, the style of writing is quite complicated and written in the familiar old fashioned Victorian style (who says halloa nowadays? but this is standard in ghost stories, even modern day ghost stories use some old fashioned words because it seems to work better. Dickens use of adjectives to create a brooding and supernatural atmosphere is typical of ghost stories, the cutting which is overshadowed by trees leaving little light to shine through is described as a dungeon suggesting a claustrophobic and imprisoned atmosphere which is typical of a ghost story. Rarely are ghost stories set in wide sprawling open spaces and this is no exception. Dickens describes the tunnel (using quite simple adjectives) as having a gloomy entrance and the actual tunnel itself being black and the signal box as dismal. But he then goes onto describe the mouth of the tunnel as described as having a barbarous, depressing and forbidding air and then the narrator feels as though he had left the natural world like he had entered hell, then he goes on to describe the sounds the wind blowing through the telegraph wires make:- But do listen for a moment to the wind. and the wild harp it makes of the telegraph wires Language like this adds plenty of atmosphere to this already evil location and gives it a supernatural air. Ghost stories always have plenty of atmosphere (so this is a typical feature) by using language like this the story makes you feel as though you are actually there in this evil setting with all the disturbing features present. Dickens describes the feeling of the train coming as a violent pulsation like it was an evil force, you get a real feeling of how noisy and powerful this thundering beast is. Dickens also uses descriptive writing when the narrators what its like walking down the steep sides of the cutting:- It was made through a clammy stone, that became oozier and wetter as I went down Which suggests to me that the closer he gets to the railway line, the more evil and forbidding the location becomes as though youve stepping from one world to the next just by going down this steep cutting. The two characters are described very well as the narrator has an all-knowing, conf ident air. When thinking of what to do next after listening to the signalmans stories, the narrator thinks to himself:- I had proved the man to be intelligent, vigilant, painstaking and exact; but how long might it remain so, in his state of mind? The confident narrator uses quite long, complex, fluent sentences as if he knows what he was talking about and is not at all fazed by the ghost stories he had been told and does not even consider the signalmans stories to be true. He stands by the idea that he is right and what he knows what to do next. The narrator says when commenting on his past education says to himself:- He had run wild, misused his opportunities, gone down and never risen again Suggesting that he would never rise to the same level as he (the narrator) was on and that it was a shame the signalman had missed his chance. The narrator seemed to have summed the signalman up before hed got to know him personally or heard any of his past, like he was judging a book by its cover. The reticent, jumpy, nervous air of the signalmans conversations puts a message across to me that this man is scared of something. He is described as having an attitude of expectation and watchfulness, suggesting that something is going to happen. He speaks in much shorter bursts of sentences, no long passive ones here At the danger light, It WAS there, No it was silent. The signalman also shouts to get a point across like he is agitated and on the edge. It is typical for ghost stories for the confident character to use long and fluent sentences and the nervous victim, to use short sentences because he has a lot on his mind, is distracted and does not have time to think. In the first half of a ghost story words such as calm and confident are used to describe the thoughts and feelings of the sceptical character. But the end of the story uses words such as terror and horror used to describe his feelings and thoughts. This is because the sceptical character is not sceptical anymore or confident because he as experienced something terrifying. This is typical of a ghost story for the words to describe his/her state of mind to change completely by the end of the story. The signalman himself is described as dark, sombre and with heavy eyebrows which reminds me of Scrooges appearance in A Christmas Carol. One other typical aspect of ghost stories is there is never any detailed description of the ghost itself at all (if there is one in the story, it may just be a ghostly presence), the story uses suggestion. This is how the signalman describes the ghost:- and I saw this someone else standing by the red light Was the figure dark? Was it a woman or man? All we know from the text was that it was intangible, you have to use your imagination for the rest. This is also typical of ghost stories where you have to use youre imagination. Conclusion Is The Signalman a typical ghost story? I think most of you already knew the answer to this one-of course it is. It has so many of the patented features of ghost stories, the dark, bleak and isolated setting (away from civilisation and help), the spirit appearing one moonlit night, which also means strange shadows. Then there is the two main characters-one nervous and subdued, one confident and rational. The ghost only appears when the victims alone. There is nothing the signalman can do to get rid of the spirit and the ending of the story is typically enigmatic leaving an air of mystery. The list goes on, but the typical elements are what makes it such a good read, without these features it would not be a proper ghost story in my opinion, it would be very hard to write a ghost story without any of these features. Personally I thought The Signalman was a brilliant ghost story which really made me shiver. Its the little details such as the gloomy red warning light, the way the telegraph wires made a noise when its windy and the dark, gloomy tunnel were the factors which were particularly disturbing for me. The fact that it was set in such a lonely place made it all the more scarier, but the surprising twist at the end was probably the best part of the story (where we find out the strange coincidence between the driver, the narrator and the ghost). I prefer stories (such as this) which have a surprising ending, which leaves an air of mystery and makes you think and question the issues in the story, long after you have turned the last page. Although they are quite different in terms of the actual story, Id say that The Signalman is probably not as accomplished and well-rounded as Dickenss other story A Christmas Carol(A Christmas Carol has more of a feel good ending than The Signalman which I preferred to this quite sad one). None the less, The Signalman is more disturbing and scarier and creates a better atmosphere than A Christmas Carol which is an essential part in any ghost story. A brilliant typical ghost story.

Adaptions in Ectothermic and Endothermic animals to extreme climates essays

Adaptions in Ectothermic and Endothermic animals to extreme climates essays First of all we need to understand what ectothermic and endothermic animals are. Animals differ in their abilities to regulate body temperature (thermoregulation). We sometimes use the terms "cold-blooded" or "warm-blooded." Most reptiles feel cold to the touch, while mammals and birds often feel warm. Somewhat more precise descriptions can be made by using the terms poikilothermic and homoiothermic. The body temperature of poikllotherms is relatively variable, while that of homeotherms is relatively constant. Even more useful terms are Ectothermic or Endothermic, which suggest two different mechanisms of thermoregulation. Ectotherms generally obtain heat from their external surroundings. Their body temperature varies, corresponding at any time with the temperature of their external environment. Endothermic animals, on the other hand, have relatively constant body temperatures. Their body temperature is independent of that of their external environment. Monkeys and walruses, for example, both have body temperatures of about 38aC, despite living in very different habitats. However if body temperature rises above its optimum level (usually around 40aC in mammals) then the enzyme rate inside the body will go into sharp decline. This is because enzymes are proteins, and become denatured. One of the first organs to be affected is the brain. Since the brain controls breathing and the circulation, the rise in body temperature disrupts the normal functioning of these important systems. If the body temperature decreases dramatically (hypothermia) then this will slow metabolic activity and impairs brain function. Here is a graph to show the relationship between the body temperature and environmental temperature for a cat (endotherm) and a lizard (ectotherm) Also we need to clarify what is meant by an extreme climate. In this investigation I will be using two different climates, The Desert and The Arcti...

5 Simple Steps to Snag Book Endorsements from a Marketing MBA

5 Simple Steps to Snag Book Endorsements from a Marketing MBA 5 Simple Steps to Snag Book Endorsements from a Marketing MBA Growing you book sales isnt easy. In fact, youre probably doing it incorrectly already.This post will show you how to market your book for growth.But if you want to know  all the ins-and-outs of self-publishing a book, including how to write, market, and publish your book within 90 dayswe highly recommend watching your free training first.How to get book endorsementsEndorsements are a very powerful form of social proof and trust-builder for potential readers of your book.Endorsements alone might not make your book a bestseller, but they’ll give you an advantage over other books that don’t have them.I was able to leverage my endorsement by a top influencer to promote my book on social media, on my website, and even on webinars and speaking engagements.You could place endorsements or â€Å"blurbs† on the back cover of your book, the praise sheet, or even the front cover, as you can see from my endorsement example below.But, how do you get top influencers to suppo rt your book? Here are five simple steps to get endorsements for your book.#1 Find the right influencersThe most powerful endorsements are those given by people who are well-known in your field. To select the right influencers, find out who your ideal readers admire. Post the question on targeted social media groups or ask them directly.Also, ask yourself what top influencers you follow and respect. Add their names to the list.Focus on quality over quantity, but if you don’t have enough names, search for bestselling books similar to yours and check out who endorsed them.It’s important that the influencers have a style and values similar to yours. That way, your ideal reader will be likely to be attracted to them and be familiar with their work.How do you figure out the style and values of potential endorsers? Start by visiting the â€Å"About Me† page on their website and pay attention to their branding and message. Then, visit their social media pages and focu s on the style of their posts and the content they share. You’ll get a good idea of whether the person’s values and style might be a good match for you or not.#3 Deliver value firstBecause its much easier to get a yes from someone who has already received value from you, its important that you start planning your request for endorsements in advance.For blurbs by top influencers, you might need to start the outreach process several months ahead of the publication of your book.Regardless of where you are in your journey, there’s always a way for you to bring value to the influencers and start a relationship with them.Something as simple as sending them a handwritten note about how much their message means to you, posting a video review of their book on Amazon, or recommending them on LinkedIn will help you stand out.Here are other examples of powerful ways to stand out: becoming an active member on the influencers’ social media groupsattending one of their conferencesjoining one of their paid programsYou should do this because you truly enjoy their message and not just because youre seeking endorsements. Your true intentions will come through in your communications and behaviors.Avoid going straight to the ask without having taken the time to deliver value first.#4 Prepare to askBefore you reach out to potential endorsers, do everything you can to make it as easy as possible for them to say yes.Prepare well in advance so you can find the best opportunities to ask for the endorsement, and give yourself enough time to get through gatekeepers.For example, if the influencer will be speaking at an event in your town, you could grab a ticket and introduce yourself. However, local events aren’t your only choice. One of my friends was interested in building a relationship with an influencer who would be speaking three thousand miles away.But that didnt stop her. By following the influencer on Instagram, she learned that this person l oved brownies and would be attending the event with her husband. My friend ordered a dozen brownies to be delivered to the event with a customized note that read, â€Å"Best wishes during your presentation. Hope you and your husband enjoy these treats!† That was the start of their friendship.As part of your preparation, write a sample endorsement for each influencer. Blurs usually hover around 50 words (never more than 100). If you know their work well, you will be able to create blurbs that closely match their writing voice. #5 Ask for the endorsementIt might feel nerve-wracking to ask, but never wrong. If youre hesitant, it might be too soon in the relationship, especially when it comes to top influencers. If you ask too soon, they will either ignore you or reject your proposal.Rushing might mean that you’ll have to start the process all over again and find someone else to endorse your book.Never send a mass request to a group of influencers. You’ll waste you r time, and hurt your chances of ever building a relationship with them. Customization is key.Send the influencers a copy of your book along with a well-crafted message asking for the endorsement.Ideally, you’ll send them a physical copy. It doesnt have to be the final version, and it doesnt have to be perfect. It can be a printed PDF.That said, you must ensure that whatever you send to the influencer is professionally packaged. If sending a physical version of your book is not possible, you can send them the PDF or ebook, but you’ll have to ask in a way that stands out. You could achieve this by customizing your message in a unique way, creating a video specifically designed for them, or preceding your email with a handwritten note.Think outside the box! A video card or a note written on a balloon would be clever ways to stand out, too.Be succinct. Remember that time is a high-price commodity for influencers (for everyone!) so you dont want to make it a chore to under stand what youre asking.Start by expressing why you feel theyre the right person to endorse the book and why you respect them so much. Be sure to mention that you’re eager to make your readers aware of their work. Next, specify the length of the blurb youre seeking as well as by when you need it done. Dont make your deadline too far in the future so that its put in the back burner, but dont make it so soon that the influencer will immediately say no. I personally chose 3-4 weeks to collect the blurbs.Be prepared to negotiate an extended due date, and allow for extra time in your planning.When you share the blurb that you wrote, explain that youre just trying to make things easy for them.Express how much you appreciate their time and attention, and close with the promise to follow up in a week or two.Following Up for Book EndorsementsIf you dont hear back from the influencers, its easy to assume theyre not interested in writing the endorsement and be tempted to give up. Howeve r, its important to realize that they might have not received your message yet.Emails go to spam folders. Gatekeepers delete emails and toss out mail. You never know!When you follow up, try a different way to reach the person. If you used email first, follow up with a handwritten note or a message on social media.If you find out the name of the influencers’ gatekeepers, reach out to them directly. Build a relationship with them as well, and you will have a great chance of success.My rule of thumb is to follow up three times. If you dont hear from them, it might be time to move on.As you can see, with a well-written manuscript, proper planning, and a great dose of authenticity, its possible for you to get endorsements from top influencers in your field.The most important step is to take action. Its easy to be sidelined by fear of rejection, but if you think about it, the worst thing that can happen is that they’ll say no. If youre confident in the quality of your book, you have nothing to fear. Take the first step today to gain powerful social proof and make your book a success!

Enviromental science Movie Review Example | Topics and Well Written Essays - 500 words

Enviromental science - Movie Review Example The director asks this family to keep their every scrap of the garbage for three months. Later he shows the family where it all goes and what its doing to the world. This documentary film is definitely an eye opener for everybody. The theme, which attracted me very much from this film, is the injudicious consumerism and tis consequences. Uncontrolled consumerism is one of the biggest curses facing by the current generation at present. Since modern generation do not have much financial problems compared to the older generation, they consume many wanted and unwanted things. For example, it is the habit of many people to purchase latest mobile phones even if they have good mobile phones in their hand. In other words, many of the current consumers purchase goods not because of necessity but to keep their social status. While purchasing new things, they throw away the older ones. It should be noted that mobile phones like electronic goods have many toxic elements, which has the potential to destroy our environment. For example, the lead batteries of the mobile phones have the ability to cause major environmental problems. This film warns the public a bout the negative effects of uncontrolled or injudicious consumerism. This film warns the public that â€Å"from organic waste to the stuff they flush down the potty, the plastic bags they use to the water they drink out of bottles, the air pollution they create when transporting the kids around, to using lights at Christmas, the McDonalds discover that for every action there is a reaction that affects them and the entire planet† (Nisker). The biggest drawback of this film is that it gives us many problems and failed to give ample solutions. In other words, the film mainly focussing on the problem side of uncontrolled consumerism and it says less about the possible solutions. For example, it says that 1 trillion plastic bags are used in the world every five minutes. However, it says little about the alternate options

Why is it beneficial to have both IT & Management skills together Essay

Why is it beneficial to have both IT & Management skills together - Essay Example Technology is evolving constantly with new applications to simplify how business is done. Management skills on the other hand enable a high level trend of correspondence in business impact. With the revolution of web 2.0, management training becomes a useful tool in doing online business through blogs, RSS feed as well as in the internet and communication with the proper and serious clients. Technology skills have significant impact on business in the coming years in that business strategies are easily achieved. Post & Anderson, (2006) asserts that, managers with technology skills are able to determine new technological impacts and how they can be adopted in the progress of business. It is upon the managers to become more proactive by keeping a breast of emerging trends and understanding the evasion of web 2.0 changes in the world of business models and their applications in business perspectives. Management skills combined with information technology skills enables these managerial groups to focus on what ways promising technologies impinge on business at the high level. The knowledge makes business conscious and informed in decision making on what aspects of new technologies will influence the organization in the coming year of business growth and hence provides a healthier transition of thought into strategic action to be taken and how they can be implemented within the organization or business world. According to Cather, Morris,& Wilkinson, (2001), combining the IT skills with management skills, therefore have enormous gait that help an organization or business to improve its strategies and also gives the management higher level of information to bring effectiveness of the services and products of the organization. This will also reduce time taken to adopt new business strategies based on emerging trends of technologies due to the organizational or business disinterest and lag that keeps on changing the

Services Marketing (encounter experiences) Essay

Services Marketing (encounter experiences) - Essay Example The aspect of degree of satisfaction as well as dissatisfaction is yet another problem that crops us in this regard. However, the measurement scales provided in the Annexure that details the experiences gives us a relatively better view into how satisfactory or for that matter dissatisfactory these experiences have been. In this regard, it should be mentioned at the very outset that service encounters refer to the customer’s most vivid impression of the service (Ziathaml, Bitner, Gremler & Pandit, 2011). Thus the report starts analyzing these experiences or to be more specific the service encounters from various managerial frameworks available to us as well as make comments on the degree of satisfaction or dissatisfaction it caused to the customers availing the service. Satisfactory Satisfactory experiences in terms of service encounters refer to those encounters of availing services that result in meeting the moot objective of the demand. However, nowadays, more and more serv ice sector firms are tending towards providing a more wholesome service experience to their clients and customers. In this regard, Clow and Kurtz (2003) have been of the opinion that satisfaction or dissatisfaction is known to be an episodic measure in that it normally relates to the last service experience. Thus, service quality becomes increasingly important an aspect from the point of view of services marketing as well as management of services as a whole. So far as the satisfactory service experiences are concerned, the present report presents six favorable or for that matter satisfactory service experiences are concerned, these focus on the aspects of favorable experiences that lead to repeat purchases or to be more specific result in customer loyalty. The first satisfactory service experience has been experienced has been in a cirque named Cirque de Soleil in London in the Royal Albert Hall. In spite of much hype as well as a long queue in front of the ticket counter along wit h the other encumbrances that any hyped show comes with, the cirque lived up to its expectations and thus customers left the hall satisfied. Of course, in terms of analysis, satisfaction in this case is due to the level of perfection that the show had attained given that the organizers had kept note of every minute detail thereby bringing parity as well as that they had taken care of the details of the service thereby referring to the impeccable service blueprint that they had put in action. Also, though the food has not been as exemplary as the other aspects have been, everything else has been just perfect thereby leading to an overall satisfactory service experience for the audience or for that matter, customers in this case. In this regard, a service blueprint refers to a graphic representation of the essential components of the service both front stage as well back stage (Fisk, Grove & John, 2008). In terms of the quality of food not being up to the mark, the concept of zone of tolerance comes into the picture. The food not being of the highest quality seemed to be well within the zone of tolerance and thus the customers were still happy with the overall

Hewllet-packard co Research Paper Example | Topics and Well Written Essays - 2250 words

Hewllet-packard co - Research Paper Example Hewlett-Packard was created in 1939 by two Stanford University students, Bill Hewlett and David Packard (Beer 2). The company came to be recognized for both its management practices and its innovative and reliable electronic goods (Beer 2). Its corporate culture and management techniques came to be known as the â€Å"HP way† (Beer 2). The HP way was progressive and focused on profits more than on growth in revenues, team-work, open-door management practices, high levels of employment, egalitarian pay structures, and flexible working schedules (Beer 2). These practices were a reflection of the values of the founders who placed importance on both profits and people (Beer 2). During its first four decades, Hewlett-Packard mainly sold test and measurement equipment, and it was during this time that the HP way developed (Beer 2). These test and measurement equipment products were based on cutting-edge technology which HP had developed, and could be sold at high profit margins (Beer 2). Hewlett-Packards clients were mainly engineers or other people from the technology industry who purchased these products for business applications (Beer 2). The first major transformation in Hewlett-Packards business came during the 1970s when the company launched computer and printer products, initially for business applications, and later for home use (Beer 2). The company struggled initially in the computer business, as the building of microcomputers and the development of UNIX machines demanded different skills to those required in the instruments business (Beer 2). The computer business needed large initial research and development investments, and required different co mpany divisions such as chips, software and peripherals, to work in tandem, which was a change from the decentralized model which had succeeded in the instruments business (Beer 2). For this

Please discuss the following question with philosophy ethics and Essay - 1

Please discuss the following question with philosophy ethics and knowledge - Essay Example A number of individuals have raised issues that utilitarianism is too demanding as a moral theory. Some respond by saying that it is not utilitarianism theory that places great demands on us, but rather the state of the world. Since the world is currently arranged in a such a way that many people are ill, hungry, or otherwise suffer greatly, this philosophical knowledge points out that we to do a lot. By doing a lot it means taking a number of actions towards alleviating the suffering. It is true and convincing that if everyone’s needs were largely looked after and most people were reasonably happy, utilitarianism would demand very little if anything from human beings. This is due to the fact that, if everyone’s demand were taken care of, then no one would end up striving to satisfy his/her need. It is in the process of utility maximization that different individuals end up messing up with others resulting into sorrow in the society. If everything is in control, then it means that there will be only one or two scenarios where an individual will have to come in for the purpose of achieving his/her utility. This will involve less actions or activities as compared to when there are a lot of illness, hunger and suffering among other calamities. Therefore in these few activities, utilitarianism will end up demanding very little from

The choice of PMM word report Coursework Example | Topics and Well Written Essays - 500 words

The choice of PMM word report - Coursework Example The reason for the choice of Prince2 methodology in Solent University is because it gives the project managers and directors the ability to manage the resources and project risks more effectively. Prince2 methodology also provides an organized framework of the project from the start to the end though it allows management of any deviations from plan and flexible decision points. Prince2 involves the management and the stakeholders at the same time thus providing proper communication channels between the project managers and the rest of the organization.Considering the amount of time and the funds set aside for the project, Prince2 methodology should be considered because it ensures proper budgeting and the project doesn’t run over the specified time (Office of Government Commerce, 2009). It consists of 5 phases in the project’s life cycle. These phases are covered by 8 processes namely; directing the project, planning, starting up the project, initiate the project, controlling, project delivery, managing boundaries and closing the project. Starting up a Project- The project managers ensure that all the required resources are available.The managers will hire an office, computers, furniture and other facilities to run the project and appoint the required staff. Closing the Project –the managers ensure proper termination of the project and checking the project has delivered all the required deliverables. The managers ensure that the university website provides all the intended functions. The website for Solent University will be developed using the waterfall model for the Software development life cycle (SDLC). The Water fall model is the simplest Software development life cycle. It is made up of 5 phases that are linearly organized. The 5 phases of the waterfall model are requirement analysis, system design and specification, coding and verification, testing and integration and maintenance. The

Please discuss the following question with philosophy ethics and Essay - 1

Please discuss the following question with philosophy ethics and knowledge - Essay Example A number of individuals have raised issues that utilitarianism is too demanding as a moral theory. Some respond by saying that it is not utilitarianism theory that places great demands on us, but rather the state of the world. Since the world is currently arranged in a such a way that many people are ill, hungry, or otherwise suffer greatly, this philosophical knowledge points out that we to do a lot. By doing a lot it means taking a number of actions towards alleviating the suffering. It is true and convincing that if everyone’s needs were largely looked after and most people were reasonably happy, utilitarianism would demand very little if anything from human beings. This is due to the fact that, if everyone’s demand were taken care of, then no one would end up striving to satisfy his/her need. It is in the process of utility maximization that different individuals end up messing up with others resulting into sorrow in the society. If everything is in control, then it means that there will be only one or two scenarios where an individual will have to come in for the purpose of achieving his/her utility. This will involve less actions or activities as compared to when there are a lot of illness, hunger and suffering among other calamities. Therefore in these few activities, utilitarianism will end up demanding very little from

Ethical Issues Research Assignment Paper Example | Topics and Well Written Essays - 1000 words

Ethical Issues Assignment - Research Paper Example g is an ethical issue in which a struggle between the body and mind would happen and the winner would be either the body (In case the person opts for mercy killing) or the mind (In case the person decided against the mercy killing). Proponents of mercy killing are of the opinion that it is better to assist a person medically to terminate his life, if he is in a hopeless situation. In their opinion, the person who suffers pain and discomforts should have given the right to take decision about sustaining his life in such pathetic condition. Others can cite ethical or moral issues against the mercy killing; but the ultimate sufferer would be the patient only. On the other hand, critics of mercy killing believe that only the creator has the right to take the life back of his creations. They are of the opinion that life is the most important thing in the world. Nobody has so far succeeded in unveiling the miseries about the life. Nobody knows from where we come and where we go after death. No science or technology, so far succeeded in creating an artificial life in a laboratory setup which underlines the importance and value of life on earth. Moreover critics also argue that only the creator has the right to modify or destroy creations and anything against his will would be unethical. As expected, we met strong arguments both in favour and against mercy killing during our research. We found most of the arguments of the proponents and the critics logical and valuable. It was difficult for us to take a position on this issue and our group actively discussed all the major arguments from both the sides in order to make a conclusion. Some of the arguments we found during our research are given below. The article IF MERCY KILLING BECOMES LEG, argued that mercy killing would be misused if it is made legal (IF MERCY KILLING BECOMES LEGAL). The above argument seems to be logical as the antisocial elements can kill innocent people on behalf of mercy killing in order to

Healthcare Reforms in England Issues of Efficiency

Healthcare Reforms in England Issues of Efficiency The healthcare service in England attempts to improve the overall healthcare service have been ongoing through some of the most radical reforms since its inception as a comprehensive public service since 1948. The noticeable need of a free healthcare service was essential after the state of the country due to the world war. Once the NHS was established it saw many reforms led by diverse types of governments at different times. Despite the scale of the reforms they have preserved their core principle of A free service at the point of delivery 1 till this very day. Even though they have adopted the core principle they still face huge challenges; as demands and costs are still rising, the entirety of the service is increasingly being looked at. This paper looks at the reforms the NHS has been through and analyses each reform in the light of Efficiency: the capability of the NHS, whether the reform made the NHS more competent, Equity: bringing fairness and equal right for the patients as well as the staff, Quality: whether adapting the reforms improved the patients ability to acquire different types of healthcare services without any predicament and obtain high-quality healthcare services. Methodology This paper was conjured up by the use of reports published by NHS Publications website. Journals and studies on NHS reform via the scientific database PubMed were also utilized. To gain info on the theories the NHS was formed on, management theory books by Max Weber, Henri Fayol and Frederic Winslow Taylor were used. Results/Discussion Each reform improvised the NHS in many ways, in relation to Efficiency the NHS since its inception has seen major investments and new hospitals built, employment of up to date technology allowing more patients to be seen within an applicable time and budgets been controlled efficiently with the aim to reduce costs each year allowing the NHS to run efficiently. In terms of Equity after the publication of the Black report, the NHS has improved on giving equal opportunities to its minor ethnic groups of staff. Also the equal treatment of patients regardless of their social class has been improved since the Blair era. The NHS in terms of quality has become one of the world leading healthcare providers. Measuring their services against standards set by the NHS ensured that they are meeting the set standards. The major investment in staff in 2000 saw a number of lives saved in the past 10 years. The NHS has met quality standards that are accepted by its patients and valued as a first class service. Conclusion Overall the NHS has seen many reforms which have lead to the NHS becoming a world class service. Since the reforms in the 1960s to the latest plans of the new coalition government the NHS has improved immensely in terms of efficiency, equity and quality and the future also looks bright for the NHS. Introduction: Healthcare service in England was launched in 1948 with an aim to provide universal healthcare to its citizens which is free at the point of use and available to everyone based on need, not ability to pay 1. The NHS was established after World War II where the country needed a stable healthcare service 2. The initial idea was that no-one should be deterred from seeking health services by a lack of resources and the founder Aneurin Bevan: Minster of Health stated A free service at the point of delivery 3. Till this day they have been providing free healthcare service to the citizens of England. In 1948 Sir William Beveridge, a British Economist and a Social Reformer conferred details of his radical plans for economic and social reform in post-war Britain. Sir William proposed major healthcare service changes on the basis that the country needed the abolition of want before the enjoyment of comfort and suggested a scheme where every kind of medical treatment would be available for everybody. 1,3 Pre NHS There has been some form of state-funded provision of health and social care in England prior to the NHS for 400 years.4 Prior to a health system being formed, attaining healthcare service in Britain in the 1930s and 1940s was difficult. Life expectancy was very low and thousands of people died of infectious diseases like pneumonia, meningitis, tuberculosis, diphtheria, and polio each year.4 The poor never had access to medical treatment and they relied instead on dubious and sometimes dangerous home remedies. Either that or they relied on doctors who gave their services free to the poor patients. The Hospitals charged for treatment and although the poor were reimbursed and before they received treatment they had to pay.4 Figure 1 shows the life expectancy that has changed since the NHS was introduced. Figure 1.Life expectancy changes since 1840 5 The need for free healthcare was widely recognised, but it was impossible to achieve without the support or resources of the government. A study showed that experts believed and have written extensively on the reasons of why a health service was needed.6 These included: The appearance of a view that health care was essential, not something just imparted erratically by charity The drastic effects of the war that made it possible to have a massive change of the healthcare service being provided, rather than just an incremental alteration As younger members of the country were becoming increasingly educated in the medical profession they had a view of things could be handle in a more efficient way. The hospitals having financial problems, funds not sufficing.6 Having looked at the reasons to why a health service was needed the government made plans and core principles were established: 6 Regardless of persons status they were eligible for health care, even people temporarily residing or visiting the country.ÂÂ   People could be referred to any hospital. The healthcare service was financed almost 100% from central taxationÂÂ   Care was entirely free at the point of use6 The main achievement was that the poor who in the past went without medical treatment now had access to free healthcare.6 NHS today and NHS employment NHS is one of the largest organisations in the world with an annual budget of around ÂÂ £80 billion employing more than 1.7 million people and treating over one million people every 36 hours.7 In general, healthcare service being provided within England to every single citizen is a difficult commission to undertake and consequently the system needs efficient health personnels to help run the system economically. Today the view of the healthcare service in England is that the NHS is a world leader and provides first class service that other countries envy. Countries all over the world seek to learn from the comprehensive system of general practice, and its role as the medical home for patients, providing continuity of care and coordination.8 Other countries look at English NHS system and use them as a guideline to run their healthcare system. NHS Structure The healthcare service in England has been run in a structural way with the Secretary of state and Department of Health controlling the overall NHS in England. The secretary of state for health has the responsibility of reporting to the prime minister. There are10 Strategic Health Authorities (SHAs) in England which are controlled by the Department of Health, they oversee all the activities within the NHS and the SHAs supervise all the NHS trusts in its area. Primary care plays a major role in community healthcare and is central to the NHS. Services under NHS trust (Secondary Care) include Hospitals, Mental Health services, Learning disability services and Ambulances. The overall structure of the NHS is shown below in Figure 2. 9 Although this is the current NHS structure with the new government in power, changes are to follow. Figure.2 overall structure of the Healthcare system in England 5 NHS Reforms Since its inception in 1948 the NHS has seen many reforms in terms of managing the way they provide healthcare service. The DoH has a lot of control and influence the major decisions taken in the reforms. The overall expectations of Healthcare service in England are of a high calibre, which requisites high-quality management capacity.10 In the 1980s and early 1990s prominence was on recuperating management. The recent focal point has been on development of leadership within NHS. With the new government, new ideas and plans will be imposed to see improvements in quality of healthcare being provided, cut down on costs making it more efficient and in terms of equity provide equal service to everyone. Table 1 briefly enlists the reforms that have taken place since its inception in 1948. Table.1 Reforms in the NHS: 1948-2010 Period the reforms were in place Reform and theory of Management 1948- 1960 Managers as diplomats 1960s Scientific Management and the Salmon report 1970s Classical Management, Systems Approaches and the 1974 Reorganization 1980s The Griffiths report and Managerialism 1990s Working for Patients and the Internal Market 2000 The NHS Plan (DOH 2000) and the Third Way. 2010 NHS White Paper 2010: Equity and excellence: Liberating the NHS Healthcare service and Reforms in other Developed Countries Healthcare reforms within developed countries can be analyzed in order to compare whether the healthcare services in England have been successful in its bid to ensure efficiency, equity and quality. Attempts to handle reforms of the healthcare system in the European countries have been an ongoing process for 30 years. Although the reforms have taken throughout the 30 years in different ways, their main emphasis has been on improving the cost-effectiveness of the healthcare service. In the early 1980s the EU countries were looking at cost containment. The feature in the 1990s was to endorse efficiency in terms of introducing competition and markets in the healthcare system. Since 2000 the focus has switched to effectiveness; promoting various notions of healthcare in terms of quality.11 Over the course of the 20th century the countries of Europe have established significant success in improving the healthcare service for their citizens. However they still face challenges in the form of restraining costs, improving quality and providing universal healthcare access, these have put the European healthcare services under immense pressure.11 Looking at another OECD: USA, A report on A review of health care reform in the United States assessed whether the USA have been successful in providing healthcare. The findings showed that United States spent more per capita on health care than any other OECD country, yet its health outcomes lagged behind other countries.12 This shows they are struggling with efficiency issues and are still countering challenges in providing quality healthcare service that is expected from the citizens of the USA. Especially in the last few years Healthcare reform has been a major activity of the federal government, in order to revolutionize and develop the service overall. The 3 goals of optimizing cost, access and quality still remain a challenge within the healthcare society in the U.S.12 They concluded that USA still faced many challenges in running the national healthcare service, a key challenge they face is the utter complexity of the system, with its numerous public and private providers.12 Another OECD country reviewed in terms of healthcare service being provided and the reforms that have taken place is China. A report from on From a national, centrally planned health system to a system based on the market: lessons from China concluded: China is the country that has undergone the highest number of health care reforms. Since 1978, China saw many reforms and they also followed the way as the EU countries, with the healthcare system starting from governmental, centrally planned and a collective system to ending up as a heavily market influenced system. Now, thirty years later, the Chinese government openly concede that the reforms were unsuccessful and seek innovative and fresh directions.13 This illustrates that China is also in a healthcare crisis and looking to implement different strategies in order to gain control of Chinas Healthcare system. Having reviewed the healthcare service being endowed in these developed countries, it demonstrates that they are all on an identical level as the healthcare service being provided in England and all face similar challenges. All these developed countries are looking to develop the countries overall healthcare service in terms of efficiency, equity and quality. NHS Plan 2000 and the future of NHS Since the last reform: The NHS plan 2000 14, a lot has transformed in terms of funding and operating the healthcare system in England. Especially with the new coalition governments idea of cutting budgets it is a difficult time the NHS is going through and will necessitate a lot of expertise and world class management to get through todays financial and economical predicament. An additional indication that will be taken into deliberation is the election of the new plans set out in the NHS White Paper 2010. As the new coalition government has come into authority there have been huge changes to overall budgets for the public services and this possibly will have a consequence on the way the NHS operates in England. 15 The reforms have encompassed a significant impact on the organisation and deliverance of health care service in England. Wide array of transformations have been pioneered in an attempt to ensure the NHS is managed more resourcefully and effectively. This report will examine whether these reforms have on the whole improved the healthcare system in England in terms of efficiency, equity and quality and if the publics requirements have been convened. Aims: To examine the healthcare reforms in England since its inception and to assess whether these reforms have improved factors of efficiency, equity and quality in providing healthcare. Objectives: To review the reforms in the NHS since its inception in 1948 To examine whether these reforms improved efficiency, equity and quality of healthcare To assess the key features of healthcare reforms proposed by the current government and their implications on the NHS To put forward plans for the future of the NHS Methodology: A number of sources were consulted to conjure up this paper and examine the healthcare reforms in the NHS. Scientific search engines and databases such as PubMed, Google Scholar and Science Direct (Date accessed 20/10/10) were used to gain literature reviews but results from Google Scholar and Science Direct were dismissed as they were too vague and irrelevant to this topic. With PubMed following keywords were inserted Healthcare, Reforms and England. The data was also set from 1948 to 2010 when searching for reports as this would set the inclusion criteria. The reports and journals since 1948, when the NHS was established were used. Even though history before 1948 was looked at for study purposes, reports before NHS establishment; these were regarded as the exclusion criteria as reports werent looked at prior to 1948. Healthcare service within Britain was looked at in general but for the results of this report, the inclusion criteria was healthcare service in England as it just look ed at the healthcare service being provided within England. The exclusion criterion was healthcare service in Scotland, Wales and Northern Ireland. For the first part of the report, the introduction: where the report looked at the history of the NHS. The resources used included looking at general management books looking at management theories. The classical theories of Max Weber, Frederic Taylor and Henri Fayol were the backbone of the NHS and that is why these were used. Another source to produce this paper was the Department of health (http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/index.htm) where the publications and reports about the NHS in general were looked at. This paper used a lot of publications produced by the Department of health and the NHS publications as these sources are reliable; these were seen as good foundation to work from. One of the main publications used was The NHS white paper: Equity and excellence: Liberating the NHS presented to Parliament by the Secretary of State for Health, this was a key entity in writing up this paper. As the paper didnt contract with experiments and clinical trials, it didnt look at a lot of statistics; the majority of its content was obtained from qualitative data. Results/ Discussion Having carried out the required literature searches and reading journals, reports and Department of Health Publications, results were gathered and have been shown below with the discussion of the key topics. The results look at each reform taken place in the NHS and then goes onto analyse the plans set by the new government. Having looked at the reforms and the new plans the paper than talks about efficiency, equity and quality related to each reform. Reforms in the healthcare service in England The healthcare service in the UK has undergone a number of reforms since its inception in 1948. Prior to 1948, healthcare service was provided in England but due to the increasing pressures for efficiency and quality in health services it lead to these developments and reforms in healthcare being provided. A more overtly management-oriented approach to the healthcare service delivery was adopted based on classical management theories to gain more control of the healthcare service in England. 16,17 Classical theories and Scientific Management: 1960s The NHS was based on the classical theories of Frederic Winslow Taylor, Henri Fayol and Max Weber. 16-19 Table 1: Frederic Winslow Taylors four main scientific management principles. Replacing rule-of-work thumb methods with methods based on a scientific of the tasks Scientifically train each individual rather than leave them to train themselves Cooperate with each worker to ensure that the scientific method is being followed Divide workload equally between managers and staff Table 2: Henri Fayols Modern Operational Management approach. Division of work- Specialization for efficiency Authority Responsibility- Both are related, the latter arising from the former. Discipline-Requires good superiors at all levels Unity of Command- Employee should receive orders from one superior only Unity of Direction- Each group of activities with the same objective must have one head and one plan Subordination of individual to general interest- When the two are found to differ, management must reconcile them Remuneration-Should be fair and satisfactory Centralization-Extent to which authority is concentrated or dispersed Scalar chain/line of authority-Needs to be sensible, clear and understood Order : Right thing/person in the right place Equity- Equal opportunity for everyone Stability of tenure- Unnecessary turnover is both the cause and effect of bad management Initiative- Thinking out and execution of a plan Thinking out and execution of a plan Table 3. Max Webers Bureaucratic approach. Power-Ability to get things done, often by the use of threats or sanctions Authority- Ability to get things done because of the position that justified someone in terms of legitimacy Formal approach Hierarchical authority Extensive roles and procedures- Uniformity of decisions and actions Job description- Clear-cut division of labour and High level of specialization Discipline These classical theories contributed a lot to the healthcare service in England and still do to this day.16-19 The classical writers thought of the NHS in terms of purpose and formal structure. They created a formal structure on which the NHS could run on. They also looked at job design, scientific selection and development of workers. The classical theories generally serve as a backbone to the present day NHS management. Although the classical theories made a big contribution to the healthcare service in England it had its limitations and wasnt the most effective way. One drawback was that it wasnt evidence based; it didnt look at the way staff did their tasks and didnt look at the well being of staff, the human and social aspects of work. It just treated them like machines. The theories didnt look at motivating the staff and developing them in their own interests, had they done this staffs work quality wouldve enhanced thus providing an efficient service to patients and overall improve the quality of healthcare service in England. Overall the classical theories were too concrete and fully based on rules and procedures. In terms of efficiency the theories bought a set way of running the healthcare service in England. Once the NHS was established it introduced equity as well as healthcare service was now available to anyone. The NHS was just established and with these set in place in the 1960s the qua lity of service would improve from now with further reforms to come. Salmon Report: 1960s One of the first reforms took place since the NHS was established was in the 1960s. The Salmon Report bought findings and changes which included that workload should be equally distributed between managers and practitioners.20 The NHS would also get rid of matrons and replace them with a hierarchy of nurse managers. The introduction of several additional layers to the management hierarchy; in order to improve efficiency in operating the NHS. This lead to responsibility being equally distributed and the service met its aims and objectives more efficiently. Another change was that nurse managers would contribute to the overall management of the service through the medium of consensus management teams and thus improve efficiency and quality within the NHS. Having nurse managers lead to them taking control of set responsibilities and helped in general running of tasks at ward level leading to an improvement in general quality in the healthcare service being provided. 1974 Reorganization: 1970s The aim of this reform was to attain greater integration of the healthcare service in order to provide more stability and increase efficiency. The reorganisation also introduced more central control in order to: 21 ensure policies were implemented improve accountability encourage delegation develop democratic decision-making process These changes lead to a more structured way for managers to follow and enhance the quality of the healthcare service. By the mid 1970s quality was improving but there were still concerns of equity in the NHS. There were still clear differences of health sufferers in terms of social class; figures showed that people in lower social classes more likely suffered from diseases. There were several possible explanations for these inequalities. Natural and social selection. This would depend on the view that people who are fittest are most likely to succeed in society, and classes reflect this degree of selection. Poverty leads to ill health, through nutrition, housing and environment. Cultural and behavioural explanations. There are differences in the diet and fitness of different social classes, and in certain habits like smoking. 22,23 Overall in the 1970s the quality of healthcare service was still improving, equity issues were still a concern and in terms of efficiency they were recuperating the NHS. The Griffiths Report: 1980s This reform was a major point in NHS history, the Griffiths Report identified problems such as the healthcare service was institutionally inactive and that the local health authorities were filled with directives without being given any clear procedures to follow.24 The Griffiths report stated that changes were difficult to achieve but gave recommendations to improve the NHS. It introduced a more formal and modern way of management. It gave increased participation for managers in setting and controlling budgets. The report also gave greater emphasis on cost awareness in order to improve efficiency. A Clear and quick decision-making process was introduced to improve quality of service provided to patients. The managers in local authorities were given a more clearly defined direction and the overall staffs were better informed.24 The Internal Market Working For Patients: 1990s Another reform in the 1990s took place, this bought a new dimension to the NHS; large publicly-owned hospitals could opt to become self-managed trusts. This meant that health services could be bought by private investors i.e. patients themselves thus allowing them to take control of the way they want the service. Even large GPs could become fund holders and be both purchasers and providers of care.25 This reform lead to introduction of greater flexibility thus allowing more effective matching of patients needs and care. Money followed the patients through the system of purchasing and providing of healthcare service, this led to equity being improved as patients had more selection of services. This reform led to higher competition in providing quality healthcare service, the costs decreased and the general quality increased. The NHS Plan 2000 The NHS Plan 2000 made key findings : the NHS is a 1940s system operating in the 21st century and that it lacked of national standards. It also said that there were barriers between staff and providing services. There were a lack of clear guidelines and the NHS structure has over-centralization.14 Plans to diminish problems and propose new plans such as introducing Modern Matrons to improve the management of services, a strong leader with clinical experience and with clear authority at ward level, improve efficiency by setting standards and controlling resources these were there aims.14,26 The figure below shows the comparison of the 1948 and the new NHS model outlining the key differences. Figure.4 the key difference between the 1948 model and The NHS Plan 2000 model 14 The NHS Plan 2000: Achievements This reform set out specific targets which were achieved in order to improve efficiency, equity and quality of healthcare service in England: Over 100 new hospitals by 2010 and 500 new one-stop primary care centres Clean wards and better hospital food 7,000 extra beds in hospitals Over 3,000 GP premises modernized Modern IT systems in every hospital and GP surgery 7,500 more consultants and 2,000 more GPs 20,000 extra nurses and 6,500 extra therapists Childcare support for NHS staff with 100 on-site nurseries.26 These targets were achieved in 2008 and it led to the improvement of efficiency as the number of GPs and consultants employed were increased. The modernisation of technology and IT systems led to quality of service being improved as high investment in high quality equipment made the NHS one of the worlds top quality service. Since 2000 NHS has improved the overall service and met its objectives. NHS Implications: Equity and excellence: Liberating the NHS With the new coalition government coming into election another set of reforms have been proposed as they hope to improve the overall healthcare service in England. The main aims and objectives to improve the healthcare service are varied and very detailed but to summarise it these are the points covered:15 Increase health spending in real terms in each year of this Parliament 15and also that there goal is an NHS which achieves results that are amongst the best in the world 15. However the government will uphold the foundation that the NHS was formed on; a comprehensive service, available to all, free at the point of use and based on clinical need, not the ability to pay 15. The government than goes into detail of what they arrange to initiate to make an efficient healthcare service: acknowledge the fact that patients come first and therefore will give them greater choice and control. An example of this is that a patient will be able to choose any GP practice, consultant, and choice of treatment consequently improving equity of the service. The government endeavours to develop the healthcare outcomes: set objectives such as reduce mortality and morbidity, increase safety, and improve patient experience and outcomes for all 15. By doing this they are ensuring they are driving efficiency and improving the service. In order to achieve the objectives that the government sets, the ability for service providers to have more autonomy, responsibility and accountability will be a means to achieving efficient results. A big change will be the establishment of a NHS Commissioning Board. The board will be accountable for making sure health outcomes are achieved, allocate resources and have the lead on quality improvement and to tackle inequalities that exist in the NHS. Overall the reforms in the NHS Paper 2010 will provide the NHS with greater incentives to increase efficiency, equity and quality. Efficiency The healthcare system in England has on the whole perceived a huge improvement in terms of efficiency since its inception in 1948. A system has been established where it endows with one of the best services in the world but there are still room for improvements. An analysis of the services gives evidence such as the NHS building 100 new hospitals since 2000, therefore improving the efficiency and allowing better access for patients. 27 Even though there continue to be a lack of quality and accessibility to services across the country. The patients havent been able to impose enough pressure to force improvements. The NHS need to give patients more control over the health services they have access to improve efficiency. In 2008 investment in the NHS as a whole rose from ÂÂ £43.9bn per year in 2000, when the NHS Plan was launched, to ÂÂ £92.6bn. another measurement of efficiency is looking at numbers of early deaths from cancer, coronary heart disease and suicide; they continue to fall as services improve; over 98% of patients at Accident and Emergency (AE) Departments are seen within 4 hours; and hospital waiting lists are lower than ever, with half a million fewer patients waiting since lists were at their peak.28 One key way to achieve the set objectives is to cut down NHS managements costs by 45% over the next four years enabling them to free up investment for further improvements.28 Much has been achieved during the last five years of investment and reforms. For example, the significant investment in NHS staff, along with more flexible working, is facilitating healthcare professionals to take advantage of the freedom thus improving their commitment to the NHS. NHS staff working flexibly and using improved technology are better able to respond to patients needs and changing expectations and are achieving improvements in quality and productivity across the system.27 Since 1948, the NHS budget on average has risen over 4% in real terms each year; this is something they hope to resolve as the NHS will face a sustained and substantial financial constraint if it continues. They hope to avoid the financial crisis that happened in the NHS in the 1970s. The NHS hopes to release up to ÂÂ £20 billion of efficiency savings by 2014, which will be reinvested to suppor Healthcare Reforms in England Issues of Efficiency Healthcare Reforms in England Issues of Efficiency The healthcare service in England attempts to improve the overall healthcare service have been ongoing through some of the most radical reforms since its inception as a comprehensive public service since 1948. The noticeable need of a free healthcare service was essential after the state of the country due to the world war. Once the NHS was established it saw many reforms led by diverse types of governments at different times. Despite the scale of the reforms they have preserved their core principle of A free service at the point of delivery 1 till this very day. Even though they have adopted the core principle they still face huge challenges; as demands and costs are still rising, the entirety of the service is increasingly being looked at. This paper looks at the reforms the NHS has been through and analyses each reform in the light of Efficiency: the capability of the NHS, whether the reform made the NHS more competent, Equity: bringing fairness and equal right for the patients as well as the staff, Quality: whether adapting the reforms improved the patients ability to acquire different types of healthcare services without any predicament and obtain high-quality healthcare services. Methodology This paper was conjured up by the use of reports published by NHS Publications website. Journals and studies on NHS reform via the scientific database PubMed were also utilized. To gain info on the theories the NHS was formed on, management theory books by Max Weber, Henri Fayol and Frederic Winslow Taylor were used. Results/Discussion Each reform improvised the NHS in many ways, in relation to Efficiency the NHS since its inception has seen major investments and new hospitals built, employment of up to date technology allowing more patients to be seen within an applicable time and budgets been controlled efficiently with the aim to reduce costs each year allowing the NHS to run efficiently. In terms of Equity after the publication of the Black report, the NHS has improved on giving equal opportunities to its minor ethnic groups of staff. Also the equal treatment of patients regardless of their social class has been improved since the Blair era. The NHS in terms of quality has become one of the world leading healthcare providers. Measuring their services against standards set by the NHS ensured that they are meeting the set standards. The major investment in staff in 2000 saw a number of lives saved in the past 10 years. The NHS has met quality standards that are accepted by its patients and valued as a first class service. Conclusion Overall the NHS has seen many reforms which have lead to the NHS becoming a world class service. Since the reforms in the 1960s to the latest plans of the new coalition government the NHS has improved immensely in terms of efficiency, equity and quality and the future also looks bright for the NHS. Introduction: Healthcare service in England was launched in 1948 with an aim to provide universal healthcare to its citizens which is free at the point of use and available to everyone based on need, not ability to pay 1. The NHS was established after World War II where the country needed a stable healthcare service 2. The initial idea was that no-one should be deterred from seeking health services by a lack of resources and the founder Aneurin Bevan: Minster of Health stated A free service at the point of delivery 3. Till this day they have been providing free healthcare service to the citizens of England. In 1948 Sir William Beveridge, a British Economist and a Social Reformer conferred details of his radical plans for economic and social reform in post-war Britain. Sir William proposed major healthcare service changes on the basis that the country needed the abolition of want before the enjoyment of comfort and suggested a scheme where every kind of medical treatment would be available for everybody. 1,3 Pre NHS There has been some form of state-funded provision of health and social care in England prior to the NHS for 400 years.4 Prior to a health system being formed, attaining healthcare service in Britain in the 1930s and 1940s was difficult. Life expectancy was very low and thousands of people died of infectious diseases like pneumonia, meningitis, tuberculosis, diphtheria, and polio each year.4 The poor never had access to medical treatment and they relied instead on dubious and sometimes dangerous home remedies. Either that or they relied on doctors who gave their services free to the poor patients. The Hospitals charged for treatment and although the poor were reimbursed and before they received treatment they had to pay.4 Figure 1 shows the life expectancy that has changed since the NHS was introduced. Figure 1.Life expectancy changes since 1840 5 The need for free healthcare was widely recognised, but it was impossible to achieve without the support or resources of the government. A study showed that experts believed and have written extensively on the reasons of why a health service was needed.6 These included: The appearance of a view that health care was essential, not something just imparted erratically by charity The drastic effects of the war that made it possible to have a massive change of the healthcare service being provided, rather than just an incremental alteration As younger members of the country were becoming increasingly educated in the medical profession they had a view of things could be handle in a more efficient way. The hospitals having financial problems, funds not sufficing.6 Having looked at the reasons to why a health service was needed the government made plans and core principles were established: 6 Regardless of persons status they were eligible for health care, even people temporarily residing or visiting the country.ÂÂ   People could be referred to any hospital. The healthcare service was financed almost 100% from central taxationÂÂ   Care was entirely free at the point of use6 The main achievement was that the poor who in the past went without medical treatment now had access to free healthcare.6 NHS today and NHS employment NHS is one of the largest organisations in the world with an annual budget of around ÂÂ £80 billion employing more than 1.7 million people and treating over one million people every 36 hours.7 In general, healthcare service being provided within England to every single citizen is a difficult commission to undertake and consequently the system needs efficient health personnels to help run the system economically. Today the view of the healthcare service in England is that the NHS is a world leader and provides first class service that other countries envy. Countries all over the world seek to learn from the comprehensive system of general practice, and its role as the medical home for patients, providing continuity of care and coordination.8 Other countries look at English NHS system and use them as a guideline to run their healthcare system. NHS Structure The healthcare service in England has been run in a structural way with the Secretary of state and Department of Health controlling the overall NHS in England. The secretary of state for health has the responsibility of reporting to the prime minister. There are10 Strategic Health Authorities (SHAs) in England which are controlled by the Department of Health, they oversee all the activities within the NHS and the SHAs supervise all the NHS trusts in its area. Primary care plays a major role in community healthcare and is central to the NHS. Services under NHS trust (Secondary Care) include Hospitals, Mental Health services, Learning disability services and Ambulances. The overall structure of the NHS is shown below in Figure 2. 9 Although this is the current NHS structure with the new government in power, changes are to follow. Figure.2 overall structure of the Healthcare system in England 5 NHS Reforms Since its inception in 1948 the NHS has seen many reforms in terms of managing the way they provide healthcare service. The DoH has a lot of control and influence the major decisions taken in the reforms. The overall expectations of Healthcare service in England are of a high calibre, which requisites high-quality management capacity.10 In the 1980s and early 1990s prominence was on recuperating management. The recent focal point has been on development of leadership within NHS. With the new government, new ideas and plans will be imposed to see improvements in quality of healthcare being provided, cut down on costs making it more efficient and in terms of equity provide equal service to everyone. Table 1 briefly enlists the reforms that have taken place since its inception in 1948. Table.1 Reforms in the NHS: 1948-2010 Period the reforms were in place Reform and theory of Management 1948- 1960 Managers as diplomats 1960s Scientific Management and the Salmon report 1970s Classical Management, Systems Approaches and the 1974 Reorganization 1980s The Griffiths report and Managerialism 1990s Working for Patients and the Internal Market 2000 The NHS Plan (DOH 2000) and the Third Way. 2010 NHS White Paper 2010: Equity and excellence: Liberating the NHS Healthcare service and Reforms in other Developed Countries Healthcare reforms within developed countries can be analyzed in order to compare whether the healthcare services in England have been successful in its bid to ensure efficiency, equity and quality. Attempts to handle reforms of the healthcare system in the European countries have been an ongoing process for 30 years. Although the reforms have taken throughout the 30 years in different ways, their main emphasis has been on improving the cost-effectiveness of the healthcare service. In the early 1980s the EU countries were looking at cost containment. The feature in the 1990s was to endorse efficiency in terms of introducing competition and markets in the healthcare system. Since 2000 the focus has switched to effectiveness; promoting various notions of healthcare in terms of quality.11 Over the course of the 20th century the countries of Europe have established significant success in improving the healthcare service for their citizens. However they still face challenges in the form of restraining costs, improving quality and providing universal healthcare access, these have put the European healthcare services under immense pressure.11 Looking at another OECD: USA, A report on A review of health care reform in the United States assessed whether the USA have been successful in providing healthcare. The findings showed that United States spent more per capita on health care than any other OECD country, yet its health outcomes lagged behind other countries.12 This shows they are struggling with efficiency issues and are still countering challenges in providing quality healthcare service that is expected from the citizens of the USA. Especially in the last few years Healthcare reform has been a major activity of the federal government, in order to revolutionize and develop the service overall. The 3 goals of optimizing cost, access and quality still remain a challenge within the healthcare society in the U.S.12 They concluded that USA still faced many challenges in running the national healthcare service, a key challenge they face is the utter complexity of the system, with its numerous public and private providers.12 Another OECD country reviewed in terms of healthcare service being provided and the reforms that have taken place is China. A report from on From a national, centrally planned health system to a system based on the market: lessons from China concluded: China is the country that has undergone the highest number of health care reforms. Since 1978, China saw many reforms and they also followed the way as the EU countries, with the healthcare system starting from governmental, centrally planned and a collective system to ending up as a heavily market influenced system. Now, thirty years later, the Chinese government openly concede that the reforms were unsuccessful and seek innovative and fresh directions.13 This illustrates that China is also in a healthcare crisis and looking to implement different strategies in order to gain control of Chinas Healthcare system. Having reviewed the healthcare service being endowed in these developed countries, it demonstrates that they are all on an identical level as the healthcare service being provided in England and all face similar challenges. All these developed countries are looking to develop the countries overall healthcare service in terms of efficiency, equity and quality. NHS Plan 2000 and the future of NHS Since the last reform: The NHS plan 2000 14, a lot has transformed in terms of funding and operating the healthcare system in England. Especially with the new coalition governments idea of cutting budgets it is a difficult time the NHS is going through and will necessitate a lot of expertise and world class management to get through todays financial and economical predicament. An additional indication that will be taken into deliberation is the election of the new plans set out in the NHS White Paper 2010. As the new coalition government has come into authority there have been huge changes to overall budgets for the public services and this possibly will have a consequence on the way the NHS operates in England. 15 The reforms have encompassed a significant impact on the organisation and deliverance of health care service in England. Wide array of transformations have been pioneered in an attempt to ensure the NHS is managed more resourcefully and effectively. This report will examine whether these reforms have on the whole improved the healthcare system in England in terms of efficiency, equity and quality and if the publics requirements have been convened. Aims: To examine the healthcare reforms in England since its inception and to assess whether these reforms have improved factors of efficiency, equity and quality in providing healthcare. Objectives: To review the reforms in the NHS since its inception in 1948 To examine whether these reforms improved efficiency, equity and quality of healthcare To assess the key features of healthcare reforms proposed by the current government and their implications on the NHS To put forward plans for the future of the NHS Methodology: A number of sources were consulted to conjure up this paper and examine the healthcare reforms in the NHS. Scientific search engines and databases such as PubMed, Google Scholar and Science Direct (Date accessed 20/10/10) were used to gain literature reviews but results from Google Scholar and Science Direct were dismissed as they were too vague and irrelevant to this topic. With PubMed following keywords were inserted Healthcare, Reforms and England. The data was also set from 1948 to 2010 when searching for reports as this would set the inclusion criteria. The reports and journals since 1948, when the NHS was established were used. Even though history before 1948 was looked at for study purposes, reports before NHS establishment; these were regarded as the exclusion criteria as reports werent looked at prior to 1948. Healthcare service within Britain was looked at in general but for the results of this report, the inclusion criteria was healthcare service in England as it just look ed at the healthcare service being provided within England. The exclusion criterion was healthcare service in Scotland, Wales and Northern Ireland. For the first part of the report, the introduction: where the report looked at the history of the NHS. The resources used included looking at general management books looking at management theories. The classical theories of Max Weber, Frederic Taylor and Henri Fayol were the backbone of the NHS and that is why these were used. Another source to produce this paper was the Department of health (http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/index.htm) where the publications and reports about the NHS in general were looked at. This paper used a lot of publications produced by the Department of health and the NHS publications as these sources are reliable; these were seen as good foundation to work from. One of the main publications used was The NHS white paper: Equity and excellence: Liberating the NHS presented to Parliament by the Secretary of State for Health, this was a key entity in writing up this paper. As the paper didnt contract with experiments and clinical trials, it didnt look at a lot of statistics; the majority of its content was obtained from qualitative data. Results/ Discussion Having carried out the required literature searches and reading journals, reports and Department of Health Publications, results were gathered and have been shown below with the discussion of the key topics. The results look at each reform taken place in the NHS and then goes onto analyse the plans set by the new government. Having looked at the reforms and the new plans the paper than talks about efficiency, equity and quality related to each reform. Reforms in the healthcare service in England The healthcare service in the UK has undergone a number of reforms since its inception in 1948. Prior to 1948, healthcare service was provided in England but due to the increasing pressures for efficiency and quality in health services it lead to these developments and reforms in healthcare being provided. A more overtly management-oriented approach to the healthcare service delivery was adopted based on classical management theories to gain more control of the healthcare service in England. 16,17 Classical theories and Scientific Management: 1960s The NHS was based on the classical theories of Frederic Winslow Taylor, Henri Fayol and Max Weber. 16-19 Table 1: Frederic Winslow Taylors four main scientific management principles. Replacing rule-of-work thumb methods with methods based on a scientific of the tasks Scientifically train each individual rather than leave them to train themselves Cooperate with each worker to ensure that the scientific method is being followed Divide workload equally between managers and staff Table 2: Henri Fayols Modern Operational Management approach. Division of work- Specialization for efficiency Authority Responsibility- Both are related, the latter arising from the former. Discipline-Requires good superiors at all levels Unity of Command- Employee should receive orders from one superior only Unity of Direction- Each group of activities with the same objective must have one head and one plan Subordination of individual to general interest- When the two are found to differ, management must reconcile them Remuneration-Should be fair and satisfactory Centralization-Extent to which authority is concentrated or dispersed Scalar chain/line of authority-Needs to be sensible, clear and understood Order : Right thing/person in the right place Equity- Equal opportunity for everyone Stability of tenure- Unnecessary turnover is both the cause and effect of bad management Initiative- Thinking out and execution of a plan Thinking out and execution of a plan Table 3. Max Webers Bureaucratic approach. Power-Ability to get things done, often by the use of threats or sanctions Authority- Ability to get things done because of the position that justified someone in terms of legitimacy Formal approach Hierarchical authority Extensive roles and procedures- Uniformity of decisions and actions Job description- Clear-cut division of labour and High level of specialization Discipline These classical theories contributed a lot to the healthcare service in England and still do to this day.16-19 The classical writers thought of the NHS in terms of purpose and formal structure. They created a formal structure on which the NHS could run on. They also looked at job design, scientific selection and development of workers. The classical theories generally serve as a backbone to the present day NHS management. Although the classical theories made a big contribution to the healthcare service in England it had its limitations and wasnt the most effective way. One drawback was that it wasnt evidence based; it didnt look at the way staff did their tasks and didnt look at the well being of staff, the human and social aspects of work. It just treated them like machines. The theories didnt look at motivating the staff and developing them in their own interests, had they done this staffs work quality wouldve enhanced thus providing an efficient service to patients and overall improve the quality of healthcare service in England. Overall the classical theories were too concrete and fully based on rules and procedures. In terms of efficiency the theories bought a set way of running the healthcare service in England. Once the NHS was established it introduced equity as well as healthcare service was now available to anyone. The NHS was just established and with these set in place in the 1960s the qua lity of service would improve from now with further reforms to come. Salmon Report: 1960s One of the first reforms took place since the NHS was established was in the 1960s. The Salmon Report bought findings and changes which included that workload should be equally distributed between managers and practitioners.20 The NHS would also get rid of matrons and replace them with a hierarchy of nurse managers. The introduction of several additional layers to the management hierarchy; in order to improve efficiency in operating the NHS. This lead to responsibility being equally distributed and the service met its aims and objectives more efficiently. Another change was that nurse managers would contribute to the overall management of the service through the medium of consensus management teams and thus improve efficiency and quality within the NHS. Having nurse managers lead to them taking control of set responsibilities and helped in general running of tasks at ward level leading to an improvement in general quality in the healthcare service being provided. 1974 Reorganization: 1970s The aim of this reform was to attain greater integration of the healthcare service in order to provide more stability and increase efficiency. The reorganisation also introduced more central control in order to: 21 ensure policies were implemented improve accountability encourage delegation develop democratic decision-making process These changes lead to a more structured way for managers to follow and enhance the quality of the healthcare service. By the mid 1970s quality was improving but there were still concerns of equity in the NHS. There were still clear differences of health sufferers in terms of social class; figures showed that people in lower social classes more likely suffered from diseases. There were several possible explanations for these inequalities. Natural and social selection. This would depend on the view that people who are fittest are most likely to succeed in society, and classes reflect this degree of selection. Poverty leads to ill health, through nutrition, housing and environment. Cultural and behavioural explanations. There are differences in the diet and fitness of different social classes, and in certain habits like smoking. 22,23 Overall in the 1970s the quality of healthcare service was still improving, equity issues were still a concern and in terms of efficiency they were recuperating the NHS. The Griffiths Report: 1980s This reform was a major point in NHS history, the Griffiths Report identified problems such as the healthcare service was institutionally inactive and that the local health authorities were filled with directives without being given any clear procedures to follow.24 The Griffiths report stated that changes were difficult to achieve but gave recommendations to improve the NHS. It introduced a more formal and modern way of management. It gave increased participation for managers in setting and controlling budgets. The report also gave greater emphasis on cost awareness in order to improve efficiency. A Clear and quick decision-making process was introduced to improve quality of service provided to patients. The managers in local authorities were given a more clearly defined direction and the overall staffs were better informed.24 The Internal Market Working For Patients: 1990s Another reform in the 1990s took place, this bought a new dimension to the NHS; large publicly-owned hospitals could opt to become self-managed trusts. This meant that health services could be bought by private investors i.e. patients themselves thus allowing them to take control of the way they want the service. Even large GPs could become fund holders and be both purchasers and providers of care.25 This reform lead to introduction of greater flexibility thus allowing more effective matching of patients needs and care. Money followed the patients through the system of purchasing and providing of healthcare service, this led to equity being improved as patients had more selection of services. This reform led to higher competition in providing quality healthcare service, the costs decreased and the general quality increased. The NHS Plan 2000 The NHS Plan 2000 made key findings : the NHS is a 1940s system operating in the 21st century and that it lacked of national standards. It also said that there were barriers between staff and providing services. There were a lack of clear guidelines and the NHS structure has over-centralization.14 Plans to diminish problems and propose new plans such as introducing Modern Matrons to improve the management of services, a strong leader with clinical experience and with clear authority at ward level, improve efficiency by setting standards and controlling resources these were there aims.14,26 The figure below shows the comparison of the 1948 and the new NHS model outlining the key differences. Figure.4 the key difference between the 1948 model and The NHS Plan 2000 model 14 The NHS Plan 2000: Achievements This reform set out specific targets which were achieved in order to improve efficiency, equity and quality of healthcare service in England: Over 100 new hospitals by 2010 and 500 new one-stop primary care centres Clean wards and better hospital food 7,000 extra beds in hospitals Over 3,000 GP premises modernized Modern IT systems in every hospital and GP surgery 7,500 more consultants and 2,000 more GPs 20,000 extra nurses and 6,500 extra therapists Childcare support for NHS staff with 100 on-site nurseries.26 These targets were achieved in 2008 and it led to the improvement of efficiency as the number of GPs and consultants employed were increased. The modernisation of technology and IT systems led to quality of service being improved as high investment in high quality equipment made the NHS one of the worlds top quality service. Since 2000 NHS has improved the overall service and met its objectives. NHS Implications: Equity and excellence: Liberating the NHS With the new coalition government coming into election another set of reforms have been proposed as they hope to improve the overall healthcare service in England. The main aims and objectives to improve the healthcare service are varied and very detailed but to summarise it these are the points covered:15 Increase health spending in real terms in each year of this Parliament 15and also that there goal is an NHS which achieves results that are amongst the best in the world 15. However the government will uphold the foundation that the NHS was formed on; a comprehensive service, available to all, free at the point of use and based on clinical need, not the ability to pay 15. The government than goes into detail of what they arrange to initiate to make an efficient healthcare service: acknowledge the fact that patients come first and therefore will give them greater choice and control. An example of this is that a patient will be able to choose any GP practice, consultant, and choice of treatment consequently improving equity of the service. The government endeavours to develop the healthcare outcomes: set objectives such as reduce mortality and morbidity, increase safety, and improve patient experience and outcomes for all 15. By doing this they are ensuring they are driving efficiency and improving the service. In order to achieve the objectives that the government sets, the ability for service providers to have more autonomy, responsibility and accountability will be a means to achieving efficient results. A big change will be the establishment of a NHS Commissioning Board. The board will be accountable for making sure health outcomes are achieved, allocate resources and have the lead on quality improvement and to tackle inequalities that exist in the NHS. Overall the reforms in the NHS Paper 2010 will provide the NHS with greater incentives to increase efficiency, equity and quality. Efficiency The healthcare system in England has on the whole perceived a huge improvement in terms of efficiency since its inception in 1948. A system has been established where it endows with one of the best services in the world but there are still room for improvements. An analysis of the services gives evidence such as the NHS building 100 new hospitals since 2000, therefore improving the efficiency and allowing better access for patients. 27 Even though there continue to be a lack of quality and accessibility to services across the country. The patients havent been able to impose enough pressure to force improvements. The NHS need to give patients more control over the health services they have access to improve efficiency. In 2008 investment in the NHS as a whole rose from ÂÂ £43.9bn per year in 2000, when the NHS Plan was launched, to ÂÂ £92.6bn. another measurement of efficiency is looking at numbers of early deaths from cancer, coronary heart disease and suicide; they continue to fall as services improve; over 98% of patients at Accident and Emergency (AE) Departments are seen within 4 hours; and hospital waiting lists are lower than ever, with half a million fewer patients waiting since lists were at their peak.28 One key way to achieve the set objectives is to cut down NHS managements costs by 45% over the next four years enabling them to free up investment for further improvements.28 Much has been achieved during the last five years of investment and reforms. For example, the significant investment in NHS staff, along with more flexible working, is facilitating healthcare professionals to take advantage of the freedom thus improving their commitment to the NHS. NHS staff working flexibly and using improved technology are better able to respond to patients needs and changing expectations and are achieving improvements in quality and productivity across the system.27 Since 1948, the NHS budget on average has risen over 4% in real terms each year; this is something they hope to resolve as the NHS will face a sustained and substantial financial constraint if it continues. They hope to avoid the financial crisis that happened in the NHS in the 1970s. The NHS hopes to release up to ÂÂ £20 billion of efficiency savings by 2014, which will be reinvested to suppor